Chapter 163 - Trauma-Associated Coagulopathy

Question 1

What are the two types of trauma-associated coagulopathy?

Answer 1

1. Acute coagulopathy of trauma-shock (ACOTS) – endogenous coagulopathy that develops early in severely traumatized individuals with concurrent tissue hypoperfusion
2. Resuscitation-associated coagulopathy (RAC)
   - the syndrome that occurs later and is exacerbated by resuscitation practices

Question 2

Pathophysiology of resuscitation-associated coagulopathy?

Answer 2

The administration of crystalloid fluids contributes to TAC via clotting factor dilution and induction of hypofibrinogenemia, thereby directly impeding clot formation and lowering resultant clot strength.

Question 3

Hydroxyethyl Starch Solutions on RAC?

Answer 3

Veterinary studies investigating the in vitro effect of HES solutions on coagulation in canine blood suggest that HES solutions decrease platelet function and fibrinogen in a dose-dependent manner, but there is controversy as to whether these findings are clinically relevant.